Humana Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds Form

Description

Electrical stimulation and electromagnetic therapy have various treatment applications, one of which is accelerating wound healing. Electrical stimulation for the treatment of wounds involves the direct application of electrical current through electrodes placed in close proximity to the wound. The application of electrical stimulation could be expected to mimic the body’s bioelectrical currents and therefore enhance tissue healing.

Electromagnetic therapy, also referred to as pulsed electromagnetic induction, is the application of electromagnetic fields to the wound area, rather than direct application of electrical current. An electromagnet is a piece of metal that has become magnetized when an electric current is passed near or through it. Electromagnetic therapy uses a pulsed magnetic field to induce current. The electrical coils that generate the magnetic field are placed on the individual. (Refer to Coverage Limitations section)

Coverage Determination

Humana members may be eligible under the Plan for electrical stimulation for the treatment of wounds, as an adjunct to standard wound therapy for the following indications:

• Arterial ulcers; OR
• Chronic (30 consecutive days or greater) stage 3 or stage 4 pressure injuries; OR
• Diabetic ulcers; OR
• Venous stasis ulcers;

AND when the following criteria are met:

• Standard wound therapy has been tried for at least 30 consecutive days and there are no measurable signs of improved healing. This 30 day period may begin while the wound is acute; AND
• Performed under the direct supervision of a healthcare professional in an office or outpatient setting

Humana members may be eligible under the Plan for the continuation of electrical stimulation for the treatment of wounds for an additional 30 consecutive days, as an adjunct to standard wound therapy for the following indications:

• Documentation by the treating physician at least once per month reflects measurable signs of improved healing; AND
• Performed under the direct supervision of a healthcare professional in an office or outpatient setting; AND

Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds

Effective Date: 03/23/2023
Revision Date: 03/23/2023
Review Date: 03/23/2023
Policy Number: HUM-0500-014

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

• Electrical stimulation must be discontinued when the wound demonstrates 100% epithelialized wound bed

Note: These criteria for electrical stimulation for the treatment of wounds are consistent with the Medicare National Coverage Policy and therefore apply to Medicare members.

Coverage Limitations

Humana members may NOT be eligible under the Plan for electrical stimulation for the treatment of wounds for any indications other than those listed above, including but not limited to:

• As an initial treatment modality; OR
• Measurable signs of healing have not been demonstrated within any 30 day period of treatment; OR
• Medically unsupervised use of electrical stimulation for wound therapy including home use

This is considered experimental/investigational as it is not identified as widely used and generally accepted for any other proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for electromagnetic therapy for the treatment of wounds. This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Note: The criteria for electromagnetic therapy for the treatment of wounds are not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Additional information about chronic wounds and skin ulcers (arterial, pressure, venous stasis) may be found from the following websites:

• American Diabetes Association
• National Library of Medicine
• National Pressure Injury Advisory Panel

Medical Alternatives

Alternatives to electrical stimulation and electromagnetic therapy include, but may not be limited to, the following:

• Bioengineered skin products (please refer to Skin and Tissue Substitutes Medical Coverage Policy)
• Dressings
• Hyperbaric oxygen therapy (please refer to Hyperbaric Oxygen Therapy, Topical Oxygen Therapy Medical Coverage Policy)
• Negative pressure wound therapy (please refer to Negative Pressure Wound Therapy Medical Coverage Policy)
• Pneumatic compression pumps (please refer to Pneumatic Compression Pumps Medical Coverage Policy)
• Prescription drug therapy
• Surgery

Physician consultation is advised to make an informed decision based on an individual's health needs.

Humana may offer a disease management program for this condition. The member may call the number on his/her identification card to ask about our programs to help manage his/her care.

Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.